Androgenic alopecia: causes, treatments, and what to expect
Androgenic alopecia (male- or female-pattern hair loss) is the most common cause of progressive thinning. It’s driven by genetics and androgens—mainly dihydrotestosterone (DHT)—which shrink hair follicles over time. You’ll often notice a receding hairline and thinning at the crown in men; women tend to have general widening of the part and diffuse thinning without a receding hairline.
Diagnosis is usually straightforward: a doctor will look at your scalp, ask about family history, and may do a simple pull test or dermoscopy. If symptoms are sudden or unusual, they’ll check blood tests for thyroid function, iron status (ferritin), and sometimes vitamin D, because low levels can make thinning worse. Photos taken over months help track progress.
Quick treatment guide
Two FDA-approved, commonly used options are topical minoxidil and oral finasteride. Minoxidil (2% or 5%) is applied to the scalp daily and can thicken hair shafts and slow shedding; expect to see changes after about 3 to 6 months. Finasteride (1 mg daily) lowers DHT and can stop hair loss or regrow hair for many men—improvements often appear after 6 to 12 months. Women of childbearing age should avoid finasteride because of birth-defect risks.
Other options include topical finasteride (lower systemic exposure), dutasteride (used off-label and sometimes more potent than finasteride), low-level laser therapy (some clinical trials show modest benefit), platelet-rich plasma (PRP) injections, and hair transplant surgery for permanent restoration if thinning is stable. PRP and laser therapy have variable results; transplants are reliable but costlier and require donor hair.
Safety, expectations, and maintenance
Side effects matter. Minoxidil can cause scalp irritation and temporary increased shedding when you start. Finasteride can cause sexual side effects in a minority of men and should be discussed with a clinician. Any medical treatment is ongoing: stopping drugs usually returns hair loss to baseline within months.
Lifestyle steps help but don’t replace medical therapy. Keep protein intake adequate, treat iron deficiency if present, manage stress, avoid tight hairstyles, and skip harsh chemical treatments. Smoking correlates with worse hair health, so quitting helps overall. Supplements with proven benefit are limited—biotin helps only if you’re deficient; multivitamins are fine if diet is poor.
Pick a clear plan with your doctor: get tests if loss is sudden, try FDA-approved treatments first, and give each therapy time (at least 6 months) before judging results. If you want faster or more dramatic change, ask about PRP, laser clinics, or a hair transplant consult. Most people can slow progression and improve hair thickness with the right combo and patience.
Small tips: take photos of your scalp every month from the same angle to notice changes. Do a patch test before using new topicals. Start treatment early—people with recent thinning respond better than those with long-standing bald patches. If you’re under 25 with fast progression, see a dermatologist; they can cover prescription options and transplant candidacy. Know costs: meds are affordable, but PRP and surgery cost more and may not be covered by insurance.
